Provider Demographics
NPI:1023231255
Name:BUMGARDNER, CHARLES GAITHER (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:GAITHER
Last Name:BUMGARDNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 ALSTON CIR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7317
Mailing Address - Country:US
Mailing Address - Phone:803-315-8788
Mailing Address - Fax:
Practice Address - Street 1:240 ALSTON CIR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7317
Practice Address - Country:US
Practice Address - Phone:803-315-8788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX2780Medicaid